Answer to "How can I teach diversity?"
The important point to remember is that there is no single right way to teach diversity. Ideally, it should be incorporated into all aspects of the curriculum (horizontally and vertically) and organisation. However, when this is not possible, it should be added wherever there is an opportunity to do so, but does need someone to keep an overview, so that there is overall coherence and avoidance of too much repetition. Some repetition can be helpful in reinforcing previous learning.
A variety of teaching strategies can work, and, as with other subjects, the strategy needs to be aligned with the aims set. The principles below may be useful to consider:
Understand the needs of the audience.
Ideally, training programs will be preceded by needs analyses. These periods of systematic data collection and analysis help identify the audience characteristics, the field’s areas of improvement, and curricular emphases (Brown, 2002). First, needs analyses can identify the target trainees; for example, the needs of medical students may be different from those of senior faculty or an interprofessional audience. Needs analyses can also clarify the specific problems faced by trainees and the consequent knowledge, skills, and attitudes needed to overcome them. In situations where students are not learning in their first language attention may need to be paid how to ensure the materials are equitably accessible to all students.
Use the appropriate approach(es).
Once the needs of the student population are known, training developers can then adopt the appropriate approach. For example, EDI trainings can choose to focus on identity differently. Identity-blind frameworks minimize differences in order to promote equality and fairness; however, these may ignore the systematic disadvantages faced by underprivileged groups. Conversely, identity-conscious policies acknowledge and value differences in order to promote diversity, but may increase intergroup biases through increasing salience of stereotyping (Konrad & Linnehan, 1995; Valli, 1995). These polar approaches may be differentially appropriate depending on several factors, including audience characteristics and the training content and delivery method, and may even be alternated given specific cirumstances.
Incorporate active participation.
Training is more effective when it requires active (as opposed to passive) participation from trainees. To this end, consider incorporating activities that require critical thinking, reflection, and discussion.
Community members and patients may come in to speak about their experiences with EDI and healthcare.
Small groups may watch videos or read case studies that describe instances of EDI. These may include classic bioethics cases (e.g., delivering blood to those whose religious beliefs are against such products). Sample questions to ask afterward include: What is the role of EDI? How did EDI positively and/or negatively influence the outcomes? What could have been done to enhance results?
Simulations (e.g., having students interact with live actors) can help demonstrate sensitive vs. insensitive clinician-patient interactions.
Relatedly, students may be assigned to interview patients or individuals from different or minority backgrounds on their own. They can follow a script that focuses on experiences and concerns in the delivery of healthcare. If applicable, students should be sure to follow proper privacy guidelines (e.g., de-identifying protected information and/or obtaining informed consent).
A panel of current practitioners can speak to their EDI experiences in the field. It would be ideal to obtain a range of providers, at different levels of care and stages in career. Brief introductions can then be followed by prepared questions (e.g., “What is a time when culture was a barrier to the provision of care? What did you do in response?”) and an open forum.
Activities may be followed by discussion using a series of prompts and presentation of their take-aways to the larger class.
Regardless of the activities, trainers should emphasize that the classroom is a safe learning environment. Trainees should feel secure in participating in the activities freely, knowing that feedback is delivered developmentally rather than critically or judgmentally. Reflection is probably the most important skill you want students to develop so that the learning can be applied to other contexts.
Include the voices of stakeholders.
Whenever possible, EDI training should include the patient voice or the student voice when thinking about faculty development. There are various ways to do this (some of which are described above), but try and ensure that the mechanisms used don’t reinforce stereotypes. One person talking about their disability is not representative of disability – it is one narrative which is important, but stress that is it not the whole picture.
Stakeholders may also be expanded to include administration, leadership, and ancillary support involved in the delivery of care. For example, bioethics and regulatory boards may be required to intervene when some EDI cases escalate. Professionals in this field may provide unique insight to the resolution of such cultural and moral issues.
Develop and refresh your teaching
As an educator, model the behaviours you expect from your students. Reflect on your teaching and evaluate it. Be open to hearing student feedback and responding appropriately. There are lots of resources available on the internet, especially interactive exercises to challenge you and students. Review these carefully and critically appraise their value.
As an educator, you may have completed training in how to engage students and help them develop skills to become better learners. You may have developed a range of skills – those skills are equally applicable when teaching about diversity.
What do you think students engage with best? When in your experience do you find that they become motivated to learn?
Students are more likely to engage with the teaching they receive if they see it as relevant to their future roles as doctors (this will hardly be surprising, but it is not uncommon for us to forget this sometimes as we prepare to teach). Making diversity education relevant to clinical practice is crucial. Students rarely fail to engage when they can see how the teaching relates to their future practice so using clinical material and patients to teach diversity is likely to engage them. However, to really understand culture they need to better understand themselves in much the same way as we asked you to review earlier. Clinical examples can be a useful way to illustrate what they need to understand about themselves and how their views influence the care they provide. Students may believe that, as doctors and scientists, they are objective and deal with facts. Your role as an educator is to help them consider when factors other than facts influence the encounter between doctors and their patients. They may be more convinced if you model this as a teacher, especially if you are a clinical teacher.
They are also more likely to engage with teaching that resonates with their experience and does not alienate them. As teachers, it is important that we not make assumptions about students and their experiences.
Can you think of an example when you made assumptions about students and got it wrong?
How did that make you feel?
With hindsight and reflection what might you have done differently?
Brown, J. (2002) ‘Training Needs Assessment: A Must for Developing an Effective Training Program’, Public Personnel Management, 31(4), pp. 569–578. https://doi.org/10.1177/009102600203100412.
Konrad, A. M. and Linnehan, F. (1995) ‘Formalized HRM Structures: Coordinating Equal Employment Opportunity Or Concealing Organizational Practices?’, Academy of Management Journal, 38(3), pp. 787–820. https://doi.org/10.5465/256746.
Valli, L. (1995) ‘The Dilemma of Race: Learning to be Color Blind and Color Conscious’, Journal of Teacher Education, 46(2), pp. 120–129. https://doi.org/10.1177/0022487195046002006.